What Is Heart Failure?

Heart failure is a condition in which the heart isn't pumping as well as it should.

While the term "heart failure" (also known as congestive heart failure) may sound like the heart has stopped working, that isn't actually the case.

Still, heart failure is a serious condition that is often the end stage or final outcome of many cardiovascular conditions. (1)

The American Heart Association (AHA) reports that the number of adults living with heart failure in the United States increased from 5.7 million people from 2009 to 2012 to approximately 6.5 million in 2011 to 2014.

The AHA estimates that by 2030, more than 8 million Americans will have heart failure. (2)

While there's no cure for heart failure, medication and healthy lifestyle changes can help manage the condition and allow people to maintain a good quality of life.

When the Heart Doesn’t Pump Effectively

Congestive heart failure occurs when there's a reduction in blood flow to the body and a backup (congestion) of fluid into the lungs, liver, abdomen, and lower extremities.

But not all heart failure is congestive: A person might have shortness of breath or weakness due to heart failure and not have any fluid buildup.

During heart failure, the body tries to compensate for reduced blood flow in other ways by:

Enlarging the Heart Chamber Doing so, it can stretch more and contract more strongly in order to pump more blood. An enlarged heart can cause your body to retain fluid, your lungs to become congested with fluid, and your heart to beat irregularly.

Developing More Muscle Mass This happens because the contracting cells of the heart get bigger. This initially lets the heart pump more strongly.

Pumping Faster This is to increase your heart's output.

Diverting Blood This means taking blood away from other tissues and organs such as the kidneys, the heart, and brain.

These compensations may mask heart failure temporarily, but eventually heart failure gets worse, and people start to experience fatigue, breathing problems, and other symptoms.

This may explain why it takes some people years to realize that they have heart failure. (3)

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Which Chambers of the Heart Are Affected?

The heart's left side, right side, or both sides can be affected by heart failure. But the left side is usually affected first.

Left-Sided Heart Failure The left ventricle is larger than the other chambers and essential for normal function because it provides most of the heart's pumping power.

In left-sided (also called left ventricular) heart failure, the left side of the heart must work harder to pump the same amount of blood.

There are two types of left-sided heart failure:

Systolic Failure Also called heart failure with reduced ejection fraction (HFrEF), this occurs when the left ventricle's ability to contract declines. The heart can't pump with enough force to maintain adequate circulation for a given demand.

Diastolic Failure Also called diastolic dysfunction, heart failure with preserved ejection fraction, or HFpEF, diastolic failure occurs when the left ventricle becomes so stiff the heart can't properly fill with blood during the resting period between each beat.

Right-Sided Heart Failure Right-sided (also called right ventricular) heart failure usually occurs because of left-sided failure.

When the left ventricle fails, increased fluid pressure is transferred back through the lungs, causing increased stress and ultimately damage to the heart's right side.

When the right side loses pumping power, blood backs up in the body's veins, causing swelling or congestion in the legs, ankles, gastrointestinal tract, and liver. (3)

What Causes the Condition?

The following conditions can cause heart failure, yet many people aren't aware that they have them:

Coronary artery disease is the most common cause of heart failure. Coronary artery disease causes narrowing of the arteries that supply blood to the heart muscle.

Diabetes complications can contribute to heart failure because the condition tends to lead to hypertension and atherosclerosis, both of which have been linked to the disease.

Obesity can cause a cardiomyopathy, which is disease of the heart muscle. Being obese can also cause the heart to work much harder than it would for non-obese people.

Long-term use of certain drugs and supplements may worsen heart failure or interfere with heart failure medicines. Nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen (Advil or Motrin) and naproxen (Aleve) can elevate blood pressure and increase salt and fluid retention, putting you at risk of heart failure. Supplements like licorice and ginseng can raise your risk of high blood pressure and increase fluid retention, causing your heart to work harder.

Alcohol abuse can cause a cardiomyopathy, leading to a diseased heart muscle and a reduction in blood-pumping capacity. (4)

Lifestyle and Genetic Factors Can Increase Your Risk of Disease

Having any of the following conditions can increase your risk for heart failure:

Life Expectancy After Heart Failure

Still, the AHA reports that about half of people who develop heart failure die within five years of diagnosis. (6)

Symptoms of the Condition

The signs of heart may seem similar to those of normal aging and can be easy to ignore. Heart failure occurs because of damage to the heart muscle or when something reduces the heart’s ability to pump blood effectively.

Heart failure is a combination of symptoms rather than just one. To help identify the signs of heart failure, the Heart Failure Society of America developed the acronym FACES to use as a guide:

F: Fatigue

A: Activities limited

C: Chest congestion

E: Edema or ankle swelling

S: Shortness of breath

If you have any of these symptoms, or a combination of the signs, speak to your healthcare provider. There are a number of tests that can help confirm a diagnosis of heart failure, including a stress test, chest X-rays, blood work, and an echocardiogram.

Treatment Options for Heart Failure

Heart failure is a chronic condition and there is no cure. Still, once you’ve been diagnosed there are several things you can do to treat the condition and manage it so it does not progress. Chief among them are lifestyle changes. These include maintaining a heart-healthy diet that’s low in saturated and trans fats and cholesterol, limiting fluids, and exercising.

You may also be prescribed drugs to decrease symptoms and improve heart function.

If your doctor deems that your heart failure can’t be treated with medication and lifestyle changes, surgery may be necessary.

What Is Edema?

Edema is the swelling that is caused by excess fluid trapped in the body’s tissue.

The condition often occurs as the result of congestive heart failure. It can also be the result of medication, pregnancy, or another underlying condition, like kidney disease or cirrhosis of the liver.

Signs that you have edema include:

Swelling or puffiness of the tissue directly under the skin, especially in the legs or arms

Arms or legs start to feel full or heavy

Shiny or stretched skin

Skin that retains pits, or a dimple, after being pressed for several seconds

Clothing or jewelry starts to feel tight and uncomfortable

Skin near the swelling feels tight or warm

It becomes more difficult to move the joints that are affected

Increased abdominal size

If you have any of these symptoms, make an appointment to see your doctor. But you should seek medical attention immediately if you experience these along shortness of breath, difficulty breathing, and chest pain. (7)

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The Link Between Heart Failure and Sleep Apnea

Sleep apnea is a common but potentially serious sleep disorder that affects an estimated 30 million people in the United States. (8) People who have sleep apnea experience interruptions in breathing that can last 10 seconds or more and occur repeatedly throughout the night, as many as 30 times or more in the span of an hour.

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Heart failure can cause retention of sodium and water, and doctors suspect that the excess fluid may enter the lungs at night and lead to obstructive apnea. Heart failure also seems to be linked to problems with the respiratory control system, which may be a cause of central sleep apnea. (9)

Tips for Living Well With Heart Failure

More On Reducing the Risk

Symptoms of heart failure can make the simplest of tasks seem daunting. But it’s possible to lead a full and active life if you learn how to perform certain activities of daily life safely and modify them as you need to.

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The researchers also say that given that many women are discharged from hospital care just a couple of days after they give birth and aren’t given a follow-up until about six weeks later, how doctors regard women who might be at risk of heart failure needs to change.

They call for comprehensive discharge health education, with emphasis on signs and symptoms to look for and when or where to seek immediate care. (10)

Resources We Love

Favorite Orgs for Essential CHF Information

The leading heart disease organization in the United States. Their online resources on heart conditions including heart failure offer clear explanations of the condition for both patients and family members, as well as links to many other tools and resources. You can also find information on your local AHA office and learn about volunteer opportunities.

The website for this society made up of researchers, clinicians, and trainees to discuss new treatments and research results in their field, also has valuable information for people living with a heart condition in their patient section. You can learn facts about CHF, and learn about apps and podcasts to help you better manage the condition.

The American College of Cardiology’s website is full of resources for patient education and empowerment. Check out basics on heart conditions, drugs and treatments, and news and events. By creating a profile, you can sign up to receive personalized newsletters and discussion guides to bring with you to your next doctor's appointment.

Favorite Apps and Gadgets

This tool from the American Heart Association can be used on a smartphone or desktop computer to track everything from daily exercise to up to 20 medications. You can even set it up to remind you when it’s time for your daily doses. An accompanying app lets you electronically share vital medical information with your doctor.

This app can help you to keep track of your liquid intake to avoid excess fluid buildup, which can lead to problems. You can also track your weight, because sudden increases in weight can be due to water retention. The great thing about this app is that it alerts you if your blood pressure or weight gets high enough that you should tell your doctor. It also allows you to send reports on your fluid intake and weight to your healthcare provider.

This app, developed in partnership with the Heart Failure Society of America, is your one-stop shop for recording symptoms, vital signs, and medications to help you manage CHF. You can also track your information and keep a journal to maintain wellness and emotional health.

Favorite Online Support Groups

Sponsored by the American Association of Heart Failure Nurses, this online support community for any person who has been affected by HF allows you to connect with others and to hear from real medical experts. There is also a resource section which has information on things like low-salt cookbooks and patient tips to get through the holidays.

This network has tracks for various heart conditions where you can post questions, share your story, and learn more about your condition. Once you sign up to become a part of the community, you will receive personalized content based on your condition and concerns.

The AHA offers an online brochure for lifestyle advice to manage heart failure, including exercise and diet. An online tutorial helps you navigate the site. Get started by clicking the three lines at the top of the page.

Favorite Patient Conference

Check out the upcoming events section of HFSA’s website to find out about symposiums, conferences, and meetings where you can learn more about the condition. Events take place all over the country, so check back frequently to find one near you.

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